Media captionThe report says resources are "stretched" across four hospitals

Cardiac services face a shake-up at four district hospitals in mid and west Wales after a critical review by a panel of UK leading heart specialists.

The report by the Royal College of Physicians calls for a specialist cardiac "hub" to be established, based at Glangwili Hospital in Carmarthen.

Data on death rates at hospitals run by the Hywel Dda University Health Board has also been questioned .

The board requested the review amid concerns over cardiac care.

Officials say they are now taking action on the report.

The four hospitals at the centre of the review are Bronglais at Aberystwyth, Withybush at Haverfordwest, Glangwili at Carmarthen, and Prince Philip at Llanelli.

The review panel looked at a number of internal documents, including letters and emails and interviewed health board staff including cardiology consultants.

'Untoward incident reports'

There had also been concern about an apparently high risk adjusted mortality index (RAMI) for cardiology patients Report, Royal College of Physicians

Health board medical director Dr Sue Fish said the review did not look at any specific issues "relating to individual patients and has not identified any parts of the service that are currently unsafe".

The report said: "The review was prompted by a number of both anecdotal and untoward incident reports about the care of patients with acute cardiological problems (primarily cardiac type chest pain) being admitted to the district general hospitals (DGHs) in the HDHB area and in particular the interface between accident and emergency (A&E), the acute medicine units (AMUs) and specialist cardiology services.

"There had also been concern about an apparently high risk adjusted mortality index (RAMI) for cardiology patients in one DGH, Withybush Hospital, and the collection of data throughout HDHB."

It has issued a number of recommendations, including creating a "hub" for cardiology care at Glangwili hospital and saying any patients arriving at any A&E unit in the health board area should be transferred to Glangwili "immediately". Other recommendations are:

Strengthen nurse specialist teams at peripheral hospitals

Make sure a consultant cardiologist is available at each of the other hospitals for at least one day a week to hold an outpatient clinic

Create an overall lead for cardiology as "there is no-one in this role at the moment"

Recalculation of Withybush mortality figures. Then a new drive to ensure accurate collection of data with one named person at each hospital to be responsible for this

The review said two cardiologists from separate hospitals independently raised concerns, referring to the "poor service patients are receiving".

"We have been reviewing all deaths in our hospitals over several of years to ensure that lessons can be learned and patient care improvedDr Sue Fish, Health board medical director

'Firm decisions'

The report said patients needing specialist treatment or surgery are sent to Morriston hospital in Swansea run by neighbouring Abertawe Bro Morgannwg Health Board with Morriston consultants "concerned that patients returning to hospitals in the Hywel Dda health board after surgery may get lost in the system with inadequate follow up".

Health board medical director Dr Sue Fish said a clinically-led project board is being set up to "discuss the report and its recommendations in detail, formulating an action plan as a matter of urgency".

She said: "The review did not look at any specific issues relating to individual patients and has not identified any parts of the service that are currently unsafe.

"We have been reviewing all deaths in our hospitals over several of years to ensure that lessons can be learned and patient care improved."

She said the health board has undertaken a further review of RAMI data and "improved the management of clinical incidents and we are ensuring that we participate in National Clinical Audits".

"It's important to stress that no decisions have been made as the project board will need to consider the recommendations with our expert clinicians before firm decisions on the best way forward are made," she said.

'Vindicated' views

Health Minister Mark Drakeford said the review "bears out many of the things I have said over the year I have been health minister - that we try to do too many things in too many parts of Wales".

He said it also came at a time when the health board was trying to reorganise the NHS locally, while faced with people "fiercely attached to the services that they have - and reforming services, to bring things together into a single centre, is very controversial indeed".

He added: "The health board has struggled with those contradictory impulses for a long time.